Provider Demographics
NPI:1619397445
Name:PHY, MEGAN DANIELLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DANIELLE
Last Name:PHY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 EDMONDS RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544-4023
Mailing Address - Country:US
Mailing Address - Phone:931-265-8071
Mailing Address - Fax:
Practice Address - Street 1:344 EDMONDS RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:TN
Practice Address - Zip Code:38544-4023
Practice Address - Country:US
Practice Address - Phone:931-265-8071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-19
Last Update Date:2014-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2382224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant